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Review| Volume 202, ISSUE 1, P5-14, January 01, 2010

Risk factors for depressive symptoms during pregnancy: a systematic review

DOI:https://doi.org/10.1016/j.ajog.2009.09.007
Risk factors for depressive symptoms during pregnancy: a systematic review
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      The purpose of this study was to evaluate risk factors for antepartum depressive symptoms that can be assessed in routine obstetric care. We evaluated articles in the English-language literature from 1980 through 2008. Studies were selected if they evaluated the association between antepartum depressive symptoms and ≥1 risk factors. For each risk factor, 2 blinded, independent reviewers evaluated the overall trend of evidence. In total, 57 studies met eligibility criteria. Maternal anxiety, life stress, history of depression, lack of social support, unintended pregnancy, Medicaid insurance, domestic violence, lower income, lower education, smoking, single status, and poor relationship quality were associated with a greater likelihood of antepartum depressive symptoms in bivariate analyses. Life stress, lack of social support, and domestic violence continued to demonstrate a significant association in multivariate analyses. Our results demonstrate several correlates that are consistently related to an increased risk of depressive symptoms during pregnancy.

      Key words

      Depression is one of the most common complications in pregnancy. As many as 12.7% of pregnant women experience a major depressive disorder.
      • Gaynes B.N.
      • Gavin N.
      • Meltzer-Brody S.
      • et al.
      Perinatal depression: prevalence, screening accuracy, and screening outcomes.
      Evid Rep Technol Assess (Summ). 2005; 119: 1-8
      Several professional organizations now recommend routine screening for antepartum depression.
      American College of Obstetricians and Gynecologists
      Committee opinion no. 343; psychosocial risk factors: perinatal screening and intervention.
      Obstet Gynecol. 2006; 108: 469-477
      , 
      National Collaborating Center for Mental Health
      Antenatal and postnatal mental health: the NICE guideline on clinical management and service guidance.
      The British Psychological Society and The Royal College of Psychiatrists, London, Great Britain2007
      In fact, the American College of Obstetricians and Gynecologists (ACOG) recommends screening for depression during each trimester of pregnancy.
      American College of Obstetricians and Gynecologists
      Committee opinion no. 343; psychosocial risk factors: perinatal screening and intervention.
      Obstet Gynecol. 2006; 108: 469-477
      For Editors' Commentary, see Table of Contents
      Prenatal care providers are uniquely suited to address antepartum depression. First of all, providers have already captured their target population, because most women will use obstetric services at some point during their pregnancies. Providers also have multiple opportunities to assess, treat, and follow-up with patients, as obstetric visits are recurring during a several-month span. Despite these qualifications, prenatal care providers are constrained by a lack of education in the evaluation and treatment of depression. Less than half of obstetricians report that residency prepared them to diagnose depression.
      • Dietrich A.J.
      • Williams J.W.
      • Ciotti M.C.
      • et al.
      Depression care attitudes and practices of newer obstetrician-gynecologists: a national survey.
      Am J Obstet Gynecol. 2003; 189: 267-273
      Although several metaanalyses have summarized risk factors for postpartum depression,
      • Beck C.T.
      A meta-analysis of predictors of postpartum depression.
      Nurs Res. 1996; 45: 297-303
      , 
      • Beck C.T.
      Predictors of postpartum depression: an update.
      Nurs Res. 2001; 50: 275-285
      , 
      • O'Hara M.W.
      • Swain A.M.
      Rates and risk of postpartum depression–a meta-analysis.
      Int Rev Psychiatry. 1996; 8: 37-54
      , 
      • Robertson E.
      • Grace S.
      • Wallington T.
      • Stewart D.E.
      Antenatal risk factors for postpartum depression: a synthesis of recent literature.
      Gen Hosp Psychiatry. 2004; 26: 289-295
      there has been no systematic synthesis of the literature regarding risk factors for depressive symptoms during pregnancy, when obstetric providers will have their most frequent contact with patients. We cannot assume that the risk factors during pregnancy are the same as those postpartum, because certain factors, such as pregnancy intention and social support, may operate differently before and after the arrival of a baby.
      If providers know the clinical significance of risk factors for depression in pregnancy, they may be able to more easily identify women with the highest chance for developing this condition. Therefore, the purpose of our study was to examine risk factors for antepartum depression that can be assessed in routine obstetric care.

      Materials and methods

      In consultation with an experienced research librarian, we developed Boolean search strategies (Appendix) with the key words “depression,” “screening,” and “pregnancy.” We searched for articles, abstracts, and dissertations from January 1980 through March 2008 in the following databases: PubMed, CINAHL, SCOPUS, PsycINFO, Sociological Abstracts, ISI Proceedings, and ProQuest Dissertations and Theses. In addition, we searched the bibliographies of a large systematic review,
      • Gaynes B.N.
      • Gavin N.
      • Meltzer-Brody S.
      • et al.
      Perinatal depression: prevalence, screening accuracy, and screening outcomes; evidence report/technology assessment no. 119. AHRQ publication no. 05-E006-2.
      Agency for Healthcare Research and Quality, Rockville, MD2005
      2 ACOG Committee Opinions,
      American College of Obstetricians and Gynecologists
      Committee opinion no. 343; psychosocial risk factors: perinatal screening and intervention.
      Obstet Gynecol. 2006; 108: 469-477
      , 
      American College of Obstetricians and Gynecologists
      Practice bulletin: clinical management guidelines for obstetrician-gynecologists no. 92; use of psychiatric medications during pregnancy and lactation.
      Obstet Gynecol. 2008; 111: 1001-1020
      and 3 medical guidelines.
      National Collaborating Center for Mental Health
      Antenatal and postnatal mental health: the NICE guideline on clinical management and service guidance.
      The British Psychological Society and The Royal College of Psychiatrists, London, Great Britain2007
      , 
      Finnish Medical Society Duodecim
      Systemic diseases in pregnancy.
      in: Kunnamo I. EBM guidelines: evidence-based medicine. Wiley Interscience, John Wiley and Sons, Helsinki, Finland2007
      , 
      Registered Nurses Association of Ontario (RNAO)
      Interventions for postpartum depression.
      Registered Nurses Association of Ontario (RNAO), Toronto, ON2005
      Finally, we hand-searched the bibliographies of each included article.
      The Figure outlines the selection process. Two independent reviewers examined each article for inclusion. If the 2 reviewers disagreed on whether to include an article, they repeated the review of inclusion/exclusion criteria and met to discuss these criteria in regard to the article in question. A third reviewer was available to resolve any disagreements that could not be resolved by consensus of the first 2 reviewers. However, all disagreements were resolved without the need for a third review.
      Figure thumbnail gr1
      FIGUREStudy selection
      *Refers to studies that assessed for depression after prenatal testing, such as amniocentesis, was performed.
      HIV, human immunodeficiency virus.
      Lancaster. Risk factors for depressive symptoms during pregnancy. Am J Obstet Gynecol 2010.
      We included studies that assessed for depressive symptoms during pregnancy and evaluated the association between depressive symptoms and ≥1 potential risk factors. We excluded studies that provided only descriptive statistics; studies in a non-English language; studies performed outside of the United States, Canada, Europe, Australia, or New Zealand; studies with an exclusively adolescent sample; studies of women with known depression at the time of screening; and case series, case reports, and review articles with no original data. In addition, we excluded studies with <20 subjects so that the included studies would have sufficient power to examine the association for at least 1 potential risk factor.
      Our initial sample contained 197 articles, covering >100 potential risk factors. Using existing guidelines and prenatal intake forms,
      American College of Obstetricians and Gynecologists
      Committee opinion no. 343; psychosocial risk factors: perinatal screening and intervention.
      Obstet Gynecol. 2006; 108: 469-477
      , 
      American Academy of Pediatrics and American College of Obstetricians and Gynecologists
      Guidelines for perinatal care.
      6th ed. AAP and ACOG, Elk Grove, IL and Washington, DC2007
      , 
      Florida Department of Health
      Healthy start prenatal screen.
      http://www.doh.state.fl.us/family/mch/pdf/DH3134.pdf
      , 
      University of Michigan Department of Obstetrics and Gynecology
      Women's hospital birth center home page.
      http://www.med.umich.edu/i/obgyn/birthcenter/index.htm
      we narrowed our analysis to include 20 risk factors that could be clinically assessed in routine obstetric practice: maternal anxiety; life stress; depression history; social support; domestic violence; unintended pregnancy; insurance status; socioeconomic status (SES); income; employment; education; age; race/ethnicity; cohabitation status; relationship quality; smoking; alcohol use; illicit drug use; parity; and obstetric history. Excluded risk factors included items such as negative self-schema and acculturation. In addition, we excluded risk factors for which there were <3 studies in the literature.
      The primary investigator developed a data extraction tool a priori that was used to assess the following article details: study design; screening method; patient characteristics; and associations between predictor variables and depression, including appropriate statistics. A second reviewer examined the extracted data for accuracy. Whenever there was insufficient information to calculate the association between a risk factor and depression, an effort was made to contact the corresponding author. If a study assessed the relationship between a predictor and depressive symptoms at multiple time points, the most conservative effect size was recorded.
      In addition, we developed an article quality assessment tool adapted from methods of the US Preventive Services Task Force
      • Harris R.D.
      • Helfand M.
      • Woolf S.H.
      • Lohr K.N.
      • Teutsch S.M.
      • Atkins D.
      Methods Work Group, U.S. Preventive Services Task Force
      Current methods of the US preventive services task force: a review of the process.
      Am J Prev Med. 2001; 20: 21-35
      and a systematic review of perinatal depression.
      • Gaynes B.N.
      • Gavin N.
      • Meltzer-Brody S.
      • et al.
      Perinatal depression: prevalence, screening accuracy, and screening outcomes; evidence report/technology assessment no. 119. AHRQ publication no. 05-E006-2.
      Agency for Healthcare Research and Quality, Rockville, MD2005
      The tool included items related to internal validity, external validity, and precision in relation to our study's key question. Therefore, these ratings reflected the quality of each article for the purpose of our study and not necessarily for the original purpose of the research. The scores from each item were summed to yield a total rating of 0-10. Two independent reviewers assessed each study for quality. When there was disagreement between raters, the article was assigned the most conservative quality score.
      The heterogeneity among studies for all risk factors precluded the use of meta-analytic techniques. For each study, the primary investigator recorded the effect size of the association between a given risk factor and depressive symptoms. The effect was recorded in units of standardized effect size, using Cohen's
      • Cohen J.
      Statistical power analysis for the behavioral sciences.
      2nd ed. Lawrence Erlbaum Associates Inc, Hillsdale, NJ1988
      definitions of small, medium, and large effects.
      Then, for each potential risk factor, 2 blinded, independent reviewers evaluated the data from the included studies. If there was consistency of effect across the studies, each reviewer determined the overall trend of association, based on the magnitude of effect sizes, statistical significance, sample size, and direction of effect. The intraclass correlation for interrater reliability was 0.86 (95% confidence interval, 0.79–0.93). Any disagreements between the 2 reviewers were resolved by consensus. In this case, the 2 reviewers met to discuss their assessments and mutually decided on the best estimate of the overall trend of association.
      For example, 11 studies involving 4696 women examined the bivariate association between maternal anxiety and antepartum depressive symptoms.
      • Armstrong D.S.
      Impact of prior perinatal loss on subsequent pregnancies.
      J Obstet Gynecol Neonatal Nurs. 2004; 33: 765-773
      , 
      • Franche R.L.
      • Mikail S.F.
      The impact of perinatal loss on adjustment to subsequent pregnancy.
      Soc Sci Med. 1999; 48: 1613-1623
      , 
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      , 
      • Grant K.A.
      • McMahon C.C.
      • Austin M.P.
      Maternal anxiety during the transition to parenthood: a prospective study.
      J Affect Disord. 2008; 108: 101-111
      , 
      • Morse C.A.
      • Buist A.
      • Durkin S.
      First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers.
      J Psychosom Obstet Gynaecol. 2000; 21: 109-120
      , 
      • Norbeck J.S.
      • Tilden V.P.
      Life stress, social support, and emotional disequilibrium in complications of pregnancy: a prospective, multivariate study.
      J Health Soc Behav. 1983; 24: 30-46
      , 
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      , 
      • Rowe H.J.
      • Fisher J.R.W.
      • Quinlivan J.A.
      Original article: are pregnant Australian women well informed about prenatal genetic screening? A systematic investigation using the multidimensional measure of informed choice.
      Aust N Z J Obstet Gynaecol. 2006; 46: 433-439
      , 
      • Söderquist J.
      • Wijma K.
      • Wijma B.
      Traumatic stress in late pregnancy.
      J Anxiety Disord. 2004; 18: 127
      , 
      • Kleiverda G.
      • Steen A.M.
      • Andersen I.
      • Everaerd W.
      • Treffers P.E.
      Physical and psychological well-being in working nulliparous women during pregnancy.
      J Psychosoma Obstet Gynaecol. 1990; 11: 165-184
      , 
      • Berle J.O.
      • Mykletun A.
      • Daltveit A.K.
      • Rasmussen S.
      • Holsten F.
      • Dahl A.A.
      Neonatal outcomes in offspring of women with anxiety and depression during pregnancy: a linkage study from the Nord-Trondelag health study (HUNT) and medical birth registry of Norway.
      Arch Womens Ment Health. 2005; 8: 181-189
      All 11 studies showed a statistically significant association. One small study showed a less than small effect size, but 5 studies showed a medium effect and 5 studies showed a large effect. Therefore, we summarized the trend of evidence as demonstrating a medium-to-large effect. Even though the 11 studies were heterogeneous in their samples, the trend of evidence was consistent across them.
      However, if heterogeneity of effect precluded our ability to assess the trend of evidence, we determined that the results were inconclusive for that particular risk factor. For example, 14 studies examined race and antepartum depression.
      • Holzman C.
      • Eyster J.
      • Tiedje L.B.
      • Roman L.A.
      • Seagull E.
      • Rahbar M.H.
      A life course perspective on depressive symptoms in mid-pregnancy.
      Matern Child Health J. 2006; 10: 127-138
      , 
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Ritter C.
      • Hobfoll S.E.
      • Lavin J.
      • Cameron R.P.
      • Hulsizer M.R.
      Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.
      Health Psychol. 2000; 19: 576-585
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      , 
      • Nicholson W.K.
      • Setse R.
      • Hill-Briggs F.
      • Cooper L.A.
      • Strobino D.
      • Powe N.R.
      Depressive symptoms and health-related quality of life in early pregnancy.
      Obstet Gynecol. 2006; 107: 798-806
      , 
      • Westdahl C.
      • Milan S.
      • Magriples U.
      • Kershaw T.S.
      • Rising S.S.
      • Ickovics J.R.
      Social support and social conflict as predictors of prenatal depression.
      Obstet Gynecol. 2007; 110: 134-140
      , 
      • Flynn H.A.
      • Marcus S.M.
      • Barry K.L.
      • Blow F.C.
      Rates and correlates of alcohol use among pregnant women in obstetrics clinics.
      Alcohol Clin Exp Res. 2003; 27: 81-87
      , 
      • Lindgren K.
      Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy.
      Res Nurs Health. 2001; 24: 203-217
      , 
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      , 
      • Hobfoll S.E.
      • Ritter C.
      • Lavin J.
      • Hulsizer M.R.
      • Cameron R.P.
      Depression prevalence and incidence among inner-city pregnant and postpartum women.
      J Consult Clin Psychol. 1995; 63: 445-453
      , 
      • Smith M.V.
      • Brunetto W.L.
      • Yonkers K.A.
      Identifying perinatal depression–sooner is better.
      Contemp OB/GYN. 2004; 49: 58
      , 
      • Ward K.D.
      • Vander Weg M.W.
      • Sell M.A.
      • Scarinci I.C.
      • Read M.C.
      Characteristics and correlates of quitting among black and white low-income pregnant smokers.
      Am J Health Behav. 2006; 30: 651-662
      , 
      • Edge D.
      • Baker D.
      • Rogers A.
      Perinatal depression among black Caribbean women.
      Health Soc Care Community. 2004; 12: 430-438
      Six studies showed a significant association (n = 3567), but in 8 studies (n = 3104) the association was not statistically significant. Seven studies showed a negligible effect, and 7 studies demonstrated a small-to-medium effect. Therefore, we concluded that the evidence is inconclusive regarding any association between race and antepartum depression.
      All final summary trends were reviewed by the entire panel of coauthors.
      Trends of evidence were stratified by bivariate and multivariate comparisons.

      Results

      A total of 159 articles met inclusion criteria (Figure). Studies were most often excluded because they did not assess predictors for depression (n = 55) or they presented only postpartum data (n = 45). A table of the excluded articles is available by request from the corresponding author (C.A.L.).
      The 159 included articles had a mean sample size of 522 subjects (SD = 1014; median = 175). Approximately half (54.1%) of the studies were performed in the United States. Seventeen studies (10.7%) were longitudinal in design, and 52 studies (32.7%) included multivariate analysis. The 159 studies used 24 different depression screeners, with the Center for Epidemiological Studies Depression Scale (31.4%), the Edinburgh Postnatal Depression Scale (18.2%), and the Beck Depression Inventory (17.0%) being the most common. Only 20 studies (12.6%) used a formal diagnostic assessment for depression.
      Overall, the mean study quality score was 6.3 (SD = 1.1). Due to the large number of studies and heterogeneity of study designs, we limited our analysis to the top 25th percentile of quality scores (≥7). In addition, to reach a score of 7, studies must have addressed quality items involved in both internal and external validity. A total of 57 studies met this quality cutoff (hereafter referred to as “high-quality studies”) and are presented in Table 1.
      TABLE 1Included studies
      StudyAssessmentCountrySample sizeMean maternal age, y (SD)Gestational age at screenPotential risk factors
      DEMDVOBPSYRELSSSTRSUB
      Affonso
      • Affonso D.
      Predictors of depression symptoms during pregnancy and postpartum.
      J Psychosom Obstet Gynaecol. 1991; 12: 255
      		HSCL, SADSUS20230 (4.72)10-14, 20-22, and 30-32 wk✓✓✓✓
      Alati et al
      • Alati R.
      • Lawlor D.A.
      • Najman J.M.
      • Williams G.M.
      • Bor W.
      • O'Callaghan M.
      Is there really a ‘J-shaped' curve in the association between alcohol consumption and symptoms of depression and anxiety? Findings from the Mater-University study of pregnancy and its outcomes.
      Addiction. 2005; 100: 643-651
      		DSSIAustralia452725 (5.0)First antenatal care visit✓
      Alvik et al
      • Alvik A.
      • Haldorsen T.
      • Groholt B.
      • Lindemann R.
      Alcohol consumption before and during pregnancy comparing concurrent and retrospective reports.
      Alcohol Clin Exp Res. 2006; 30: 510-515
      		HSCLNorway142430.8 (4.4)17-18 and 30 wk✓
      Armstrong
      • Armstrong D.S.
      Impact of prior perinatal loss on subsequent pregnancies.
      J Obstet Gynecol Neonatal Nurs. 2004; 33: 765-773
      		CESDUS4032.6 (4.6)15-32 wk✓✓
      Bennett et al
      • Bennett I.M.
      • Culhane J.F.
      • McCollum K.F.
      • Mathew L.
      • Elo I.T.
      Literacy and depressive symptomatology among pregnant Latinas with limited English proficiency.
      Am J Orthopsychiatry. 2007; 77: 243-248
      		CESDUS76626.1 (5.4)Unknown✓✓✓✓✓✓
      Bergner et al
      • Bergner A.
      • Beyer R.
      • Klapp B.F.
      • Rauchfuss M.
      Pregnancy after early pregnancy loss: a prospective study of anxiety, depressive symptomatology and coping.
      J Psychosom Obstet Gynaecol. 2008; 29: 105-113
      		DEPSGermany10832.1 (6.4)Each trimester✓✓✓✓
      Berle et al
      • Berle J.O.
      • Mykletun A.
      • Daltveit A.K.
      • Rasmussen S.
      • Holsten F.
      • Dahl A.A.
      Neonatal outcomes in offspring of women with anxiety and depression during pregnancy: a linkage study from the Nord-Trondelag health study (HUNT) and medical birth registry of Norway.
      Arch Womens Ment Health. 2005; 8: 181-189
      		HADSNorway68028.9 (4.8)Varied✓
      Bernazzani et al
      • Bernazzani O.
      • Saucier J.F.
      • David H.
      • Borgeat F.
      Psychosocial factors related to emotional disturbances during pregnancy.
      J Psychosom Res. 1997; 42: 391-402
      		BDICanada21329.3 (4.0)Second trimester✓✓✓✓✓✓
      Blaney et al
      • Blaney N.T.
      • Fernandez M.I.
      • Ethier K.A.
      • Wilson T.E.
      • Walter E.
      • Koenig L.J.
      Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.
      AIDS Patient Care STDS. 2004; 18: 405-415
      		CESDUS30728.7 (6.1)≥24 wk✓✓✓✓
      Bowen and Muhajarine
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      		EPDSCanada3923.2 (4.1)Varied (mean = 17 wk)✓✓✓✓
      Cooklin et al
      • Cooklin A.R.
      • Rowe H.J.
      • Fisher J.R.
      Employee entitlements during pregnancy and maternal psychological well-being.
      Aust N Z J Obstet Gynaecol. 2007; 47: 483-490
      		EPDS, POMSAustralia14431.3 (4.9)Third trimester✓✓
      Condon
      • Condon J.T.
      Psychological and physical symptoms during pregnancy: a comparison of male and female expectant parents.
      J Reprod Infant Psychol. 1987; 5: 207-219
      		Self-developedAustralia16525
      SD not provided;
      		Varied (58% in third trimester)✓
      Da Costa et al
      • Da Costa D.
      • Larouche J.
      • Dritsa M.
      • Brender W.
      Psychosocial correlates of prepartum and postpartum depressed mood.
      J Affect Disord. 2000; 59: 31-40
      		DACLCanada8029.1 (3.7)Every month✓✓✓
      Edge et al
      • Edge D.
      • Baker D.
      • Rogers A.
      Perinatal depression among black Caribbean women.
      Health Soc Care Community. 2004; 12: 430-438
      		EPDSEngland30128.8 (6.5)Third trimester✓
      Elsenbruch et al
      • Elsenbruch S.
      • Benson S.
      • Rucke M.
      • et al.
      Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome.
      Hum Reprod. 2007; 22: 869-877
      		ADS-KGermany89629.2 (5.0)First trimester✓
      Flynn et al
      • Flynn H.A.
      • Marcus S.M.
      • Barry K.L.
      • Blow F.C.
      Rates and correlates of alcohol use among pregnant women in obstetrics clinics.
      Alcohol Clin Exp Res. 2003; 27: 81-87
      		CESDUS113128.7 (5.3)Varied (mean = 25 wk)✓✓✓✓
      Flynn et al
      • Flynn H.A.
      • Walton M.A.
      • Chermack S.T.
      • Cunningham R.M.
      • Marcus S.M.
      Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings.
      Arch Womens Ment Health. 2007; 10: 155-161
      		CESDUS105428.2 (5.6)Varied (mean = 25 wk)✓✓✓
      Franche and Mikail
      • Franche R.L.
      • Mikail S.F.
      The impact of perinatal loss on adjustment to subsequent pregnancy.
      Soc Sci Med. 1999; 48: 1613-1623
      		BDICanada6229.8 (4.5)10-24 wk✓✓
      Glazier et al
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      		CESDCanada205230.7 (4.5)24 wk✓✓✓✓✓✓
      Grant et al
      • Grant K.A.
      • McMahon C.C.
      • Austin M.P.
      Maternal anxiety during the transition to parenthood: a prospective study.
      J Affect Disord. 2008; 108: 101-111
      		EPDS, MINIAustralia10032.0 (4.4)Third trimester✓✓
      Heaman
      • Heaman M.
      Stressful life events, social support, and mood disturbance in hospitalized and non-hospitalized women with pregnancy-induced hypertension.
      Can J Nurs Res. 1992; 24: 23-37
      		POMSCanada5628.2 (4.9)Third trimester✓✓
      Hobfoll et al
      • Hobfoll S.E.
      • Ritter C.
      • Lavin J.
      • Hulsizer M.R.
      • Cameron R.P.
      Depression prevalence and incidence among inner-city pregnant and postpartum women.
      J Consult Clin Psychol. 1995; 63: 445-453
      		BDI, SADSUS19224.5 (5.1)Second and third trimester✓✓
      Hoffman and Hatch
      • Hoffman S.
      • Hatch M.C.
      Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.
      Health Psychol. 2000; 19: 535-543
      		CESDUS66227.5 (4.5)13, 28, and 36 wk✓✓✓✓✓
      Holzman et al
      • Holzman C.
      • Eyster J.
      • Tiedje L.B.
      • Roman L.A.
      • Seagull E.
      • Rahbar M.H.
      A life course perspective on depressive symptoms in mid-pregnancy.
      Matern Child Health J. 2006; 10: 127-138
      		CESDUS1321
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		16-26 wk✓✓✓✓
      Jesse et al
      • Jesse D.E.
      • Seaver D.C.
      • William W.W.
      Maternal psychosocial risks predict preterm birth in a group of women from Appalachia.
      Midwifery. 2003; 19: 191-202
      		Self-developedUS120
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		16-28 wk✓✓✓✓✓
      Jesse
      • Jesse D.E.
      Prenatal psychosocial needs: differences between a TennCare group and a privately insured group in Appalachia.
      J Health Care Poor Underserved. 2003; 14: 535-549
      		Self-developedUS120
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		16-28 wk✓
      Jesse et al
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      		BDIUS128
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		16-28 wk✓✓✓✓✓
      Kleiverda et al
      • Kleiverda G.
      • Steen A.M.
      • Andersen I.
      • Everaerd W.
      • Treffers P.E.
      Physical and psychological well-being in working nulliparous women during pregnancy.
      J Psychosoma Obstet Gynaecol. 1990; 11: 165-184
      		HSCLNetherlands17028.9
      SD not provided;
      		18 and 34 wk✓✓✓✓
      Larsson et al
      • Larsson C.
      • Sydsjö G.
      • Josefsson A.
      Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms.
      Obstet Gynecol. 2004; 104: 459-466
      		EPDSSweden1489
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		35-36 wk✓✓✓✓✓
      Leathers and Kelley
      • Leathers S.J.
      • Kelley M.A.
      Unintended pregnancy and depressive symptoms among first-time mothers and fathers.
      Am J Orthopsychiatry. 2000; 70: 523-531
      		CESDUS12430 (4.1)2-3 mo before birth✓✓✓
      Lindgren
      • Lindgren K.
      Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy.
      Res Nurs Health. 2001; 24: 203-217
      		CESDUS25229.5 (6.1)20-40 wk✓✓✓
      Morse et al
      • Morse C.A.
      • Buist A.
      • Durkin S.
      First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers.
      J Psychosom Obstet Gynaecol. 2000; 21: 109-120
      		EPDSAustralia25130
      Median 27.
      		24-26 and 36 wk✓✓✓✓✓
      Najman et al
      • Najman J.M.
      • Morrison J.
      • Williams G.
      • Andersen M.
      • Keeping J.D.
      The mental health of women 6 months after they give birth to an unwanted baby: a longitudinal study.
      Soc Sci Med. 1991; 32: 241-247
      		DSSIAustralia6642
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		First clinic visit (mean = 18 wk)✓
      Nicholson et al
      • Nicholson W.K.
      • Setse R.
      • Hill-Briggs F.
      • Cooper L.A.
      • Strobino D.
      • Powe N.R.
      Depressive symptoms and health-related quality of life in early pregnancy.
      Obstet Gynecol. 2006; 107: 798-806
      		CESDUS17528 (6.2)≤20 wk (mean = 14.6 wk)✓✓✓✓
      Norbeck and Tilden
      • Norbeck J.S.
      • Tilden V.P.
      Life stress, social support, and emotional disequilibrium in complications of pregnancy: a prospective, multivariate study.
      J Health Soc Behav. 1983; 24: 30-46
      		DACLUS11726.2 (4.2)12-20 wk (mean = 16.2 wk)✓
      O'Heron
      • O'Heron C.A.
      Coping and postpartum depression: an analysis of coping and depression during pregnancy and the puerperium [dissertation].
      University of Missouri–St Louis, St Louis, MO1991
      		BDI, SCIDUS9228.5
      SD not provided;
      		Second-third trimester✓✓✓✓
      Orr and Miller
      • Orr S.T.
      • Miller C.A.
      Unintended pregnancy and the psychosocial well-being of pregnant women.
      Womens Health Issues. 1997; 7: 38-46
      		CESDUS1163
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		First prenatal care visit✓
      Pajulo et al
      • Pajulo M.
      • Savonlahti E.
      • Sourander A.
      • Helenius H.
      • Piha J.
      Antenatal depression, substance dependency and social support.
      J Affect Disord. 2001; 65: 9-17
      		EPDSFinland39128 (4.8)18-35 wk (mean = 23 wk)✓✓✓✓✓
      Pascoe et al
      • Pascoe J.M.
      • Milburn M.
      • Haynes K.
      Correlates of first trimester care in a public health prenatal clinic.
      Fam Med. 1990; 22: 25-28
      		CESDUS105
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		Varied✓
      Pascoe et al
      • Pascoe J.M.
      • Kokotailo P.K.
      • Broekhuizen F.F.
      Correlates of multigravida women's binge drinking during pregnancy: a longitudinal study.
      Arch Pediatr Adolesc Med. 1995; 149: 1325-1329
      		CESDUS13924.5 (2.3)24-28 wk✓✓
      Records and Rice
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      		CESDUS13927 (5.2)Third trimester✓✓✓✓✓✓
      Ritter et al
      • Ritter C.
      • Hobfoll S.E.
      • Lavin J.
      • Cameron R.P.
      • Hulsizer M.R.
      Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.
      Health Psychol. 2000; 19: 576-585
      		BDIUS19124.5
      SD not provided;
      		Second and third trimester✓✓✓
      Rodriguez et al
      • Rodriguez M.A.
      • Heilemann M.V.
      • Fielder E.
      • Ang A.
      • Nevarez F.
      • Mangione C.M.
      Intimate partner violence, depression, and PTSD among pregnant Latina women.
      Ann Fam Med. 2008; 6: 44-52
      		BDIUS21027.7 (5.8)≥12 wk✓✓
      Rowe et al
      • Rowe H.J.
      • Fisher J.R.W.
      • Quinlivan J.A.
      Original article: are pregnant Australian women well informed about prenatal genetic screening? A systematic investigation using the multidimensional measure of informed choice.
      Aust N Z J Obstet Gynaecol. 2006; 46: 433-439
      		HADSAustralia13429.1 (4.7)8-14 wk (mean = 12 wk)✓
      Rubertsson
      • Rubertsson C.
      Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample.
      J Reprod Infant Psychol. 2003; 21: 113-123
      		EPDSSweden3011
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		15 wk✓✓✓✓✓
      Seguin et al
      • Seguin L.
      • Potvin L.
      • St-Denis M.
      • Loiselle J.
      Chronic stressors, social support, and depression during pregnancy.
      Obstet Gynecol. 1995; 85: 583-589
      		BDICanada14424.2 (5.0)30 wk✓✓✓✓✓
      Smith et al
      • Smith M.V.
      • Brunetto W.L.
      • Yonkers K.A.
      Identifying perinatal depression–sooner is better.
      Contemp OB/GYN. 2004; 49: 58
      		PHQUS387
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		Varied (mean = 24 wk)✓
      Söderquist et al
      • Söderquist J.
      • Wijma K.
      • Wijma B.
      Traumatic stress in late pregnancy.
      J Anxiety Disord. 2004; 18: 127
      		BDISweden95128.7 (4.5)12-20 wk (mean = 18 wk)✓
      Tilden
      • Tilden V.P.
      The relation of selected psychosocial variables to single status of adult women during pregnancy.
      Nurs Res. 1984; 33: 102-107
      		DACLUS14126.3
      SD not provided;
      		Second trimester✓
      van de Pol et al
      • van de Pol G.G.
      • Van Brummen H.J.
      • Bruinse H.W.
      • Heintz A.P.
      • Van Der Vaart C.H.
      Is there an association between depressive and urinary symptoms during and after pregnancy?.
      Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 1409-1415
      		CESDNetherlands51130 (3.6)12 and 36 wk✓✓✓
      Vander Weg et al
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      		CESDUS24525.6 (5.2)Unknown✓✓✓
      Ward et al
      • Ward K.D.
      • Vander Weg M.W.
      • Sell M.A.
      • Scarinci I.C.
      • Read M.C.
      Characteristics and correlates of quitting among black and white low-income pregnant smokers.
      Am J Health Behav. 2006; 30: 651-662
      		CESDUS24824.2 (5.1)Varied (mean = 21 wk)✓✓
      Westdahl et al
      • Westdahl C.
      • Milan S.
      • Magriples U.
      • Kershaw T.S.
      • Rising S.S.
      • Ickovics J.R.
      Social support and social conflict as predictors of prenatal depression.
      Obstet Gynecol. 2007; 110: 134-140
      		CESDUS104720.4 (2.6)Second trimester (mean = 18 wk)✓✓✓✓
      Zayas et al
      • Zayas L.H.
      • Jankowski K.R.
      • McKee M.D.
      Prenatal and postpartum depression among low-income Dominican and Puerto Rican women.
      Hispanic J Behav Sci. 2003; 25: 370-385
      		BDIUS10625 (5.6)Third trimester✓✓✓✓✓
      Zelkowitz et al
      • Zelkowitz P.
      • Schinazi J.
      • Katofsky L.
      • et al.
      Factors associated with depression in pregnant immigrant women.
      Transcultural Psychiatry. 2004; 41: 445-464
      		EPDSCanada11930.6 (4.9)Varied (mean = 29 wk)✓✓✓✓✓
      Zuckerman et al
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      		CESDUS1014
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		First or second prenatal care visit✓✓✓✓✓✓✓
      Zuckerman et al
      • Zuckerman B.
      • Bauchner H.
      • Parker S.
      • Cabral H.
      Maternal depressive symptoms during pregnancy, and newborn irritability.
      J Dev Behav Pediatr. 1990; 11: 190-194
      		CESDUS1123
      Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59: 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y);
      		Unknown✓
      ADS-K, Allgemeine Depressions Skala (German version of CESD); BDI, Beck Depression Inventory; CESD, Center for Epidemiological Studies Depression Scale; DACL, Depression Adjective Checklist; DEM, demographic factors (age, race, income, education, employment, insurance status, socioeconomic status); DEPS, the Depression Scale; DSSI, Delusions-Symptoms-States Inventory; DV, domestic violence; EPDS, Edinburgh Postnatal Depression Scale; HADS, Hospital Anxiety and Depression Scale; HSCL, Hopkins Symptom Checklist; MINI, Mini International Neuropsychiatric Interview; OB, obstetric factors (pregnancy intention, parity, obstetric history); PHQ, Patient Health Questionnaire; POMS, Profile of Mood States; PSY, psychiatric factors (history of depression, maternal anxiety); REL, relationship factors (cohabitation status, relationship quality); SADS, Schedule for Affective Disorders and Schizophrenia; SCID, Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders; SS, social support; STR, life stress; SUB, substance abuse (tobacco, alcohol, illicit drugs).
      Lancaster. Risk factors for depressive symptoms during pregnancy. Am J Obstet Gynecol 2010.
      a SD not provided;
      b Mean not provided (Holzman et al
      • Holzman C.
      • Eyster J.
      • Tiedje L.B.
      • Roman L.A.
      • Seagull E.
      • Rahbar M.H.
      A life course perspective on depressive symptoms in mid-pregnancy.
      Matern Child Health J. 2006; 10: 127-138
      : 56% aged 20-29 y), (Jesse et al
      • Jesse D.E.
      • Seaver D.C.
      • William W.W.
      Maternal psychosocial risks predict preterm birth in a group of women from Appalachia.
      Midwifery. 2003; 19: 191-202
      : 83% adult), (Jesse
      • Jesse D.E.
      Prenatal psychosocial needs: differences between a TennCare group and a privately insured group in Appalachia.
      J Health Care Poor Underserved. 2003; 14: 535-549
      : 83% ≥20 y), (Jesse et al
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      : 78% ≥20 y), (Larsson et al
      • Larsson C.
      • Sydsjö G.
      • Josefsson A.
      Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms.
      Obstet Gynecol. 2004; 104: 459-466
      : 71% aged 25-34 y), (Najman et al
      • Najman J.M.
      • Morrison J.
      • Williams G.
      • Andersen M.
      • Keeping J.D.
      The mental health of women 6 months after they give birth to an unwanted baby: a longitudinal study.
      Soc Sci Med. 1991; 32: 241-247
      : 51% aged 19-25 y), (Orr and Miller
      • Orr S.T.
      • Miller C.A.
      Unintended pregnancy and the psychosocial well-being of pregnant women.
      Womens Health Issues. 1997; 7: 38-46
      : all subjects ≥18 y), (Pascoe et al
      • Pascoe J.M.
      • Milburn M.
      • Haynes K.
      Correlates of first trimester care in a public health prenatal clinic.
      Fam Med. 1990; 22: 25-28
      : 48% aged 20-25 y), (Rubertsson
      • Rubertsson C.
      Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample.
      J Reprod Infant Psychol. 2003; 21: 113-123
      : 70% aged 25-35 y), (Smith et al
      • Smith M.V.
      • Brunetto W.L.
      • Yonkers K.A.
      Identifying perinatal depression–sooner is better.
      Contemp OB/GYN. 2004; 49: 58
      : 80% ≥20 y), (Zuckerman et al
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      : 49% aged 21-29 y), (Zuckerman et al
      • Zuckerman B.
      • Bauchner H.
      • Parker S.
      • Cabral H.
      Maternal depressive symptoms during pregnancy, and newborn irritability.
      J Dev Behav Pediatr. 1990; 11: 190-194
      : 83% >18 y);
      c Median 27.
      We included 20 potential predictor variables for antepartum depressive symptoms. Table 2 displays the overall trend of association for each potential risk factor.
      TABLE 2Potential risk factors for antepartum depression
      FactorTotal no. of studiesTotal no. of subjectsBivariate trend of association
      Results were not pooled for meta-analysis but rather represent review of overall trend of evidence as described in “Materials and Methods”;
      		Multivariate trend of association
      Results were not pooled for meta-analysis but rather represent review of overall trend of evidence as described in “Materials and Methods”;
      Anxiety
      • Armstrong D.S.
      Impact of prior perinatal loss on subsequent pregnancies.
      J Obstet Gynecol Neonatal Nurs. 2004; 33: 765-773
      , 
      • Franche R.L.
      • Mikail S.F.
      The impact of perinatal loss on adjustment to subsequent pregnancy.
      Soc Sci Med. 1999; 48: 1613-1623
      , 
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      , 
      • Grant K.A.
      • McMahon C.C.
      • Austin M.P.
      Maternal anxiety during the transition to parenthood: a prospective study.
      J Affect Disord. 2008; 108: 101-111
      , 
      • Morse C.A.
      • Buist A.
      • Durkin S.
      First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers.
      J Psychosom Obstet Gynaecol. 2000; 21: 109-120
      , 
      • Norbeck J.S.
      • Tilden V.P.
      Life stress, social support, and emotional disequilibrium in complications of pregnancy: a prospective, multivariate study.
      J Health Soc Behav. 1983; 24: 30-46
      , 
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      , 
      • Rowe H.J.
      • Fisher J.R.W.
      • Quinlivan J.A.
      Original article: are pregnant Australian women well informed about prenatal genetic screening? A systematic investigation using the multidimensional measure of informed choice.
      Aust N Z J Obstet Gynaecol. 2006; 46: 433-439
      , 
      • Söderquist J.
      • Wijma K.
      • Wijma B.
      Traumatic stress in late pregnancy.
      J Anxiety Disord. 2004; 18: 127
      , 
      • Kleiverda G.
      • Steen A.M.
      • Andersen I.
      • Everaerd W.
      • Treffers P.E.
      Physical and psychological well-being in working nulliparous women during pregnancy.
      J Psychosoma Obstet Gynaecol. 1990; 11: 165-184
      , 
      • Berle J.O.
      • Mykletun A.
      • Daltveit A.K.
      • Rasmussen S.
      • Holsten F.
      • Dahl A.A.
      Neonatal outcomes in offspring of women with anxiety and depression during pregnancy: a linkage study from the Nord-Trondelag health study (HUNT) and medical birth registry of Norway.
      Arch Womens Ment Health. 2005; 8: 181-189
      		114696++++
      Could not give summary due to lack of sample size (see text for discussion);
      Life stress, composite
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      , 
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      , 
      • Holzman C.
      • Eyster J.
      • Tiedje L.B.
      • Roman L.A.
      • Seagull E.
      • Rahbar M.H.
      A life course perspective on depressive symptoms in mid-pregnancy.
      Matern Child Health J. 2006; 10: 127-138
      , 
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Ritter C.
      • Hobfoll S.E.
      • Lavin J.
      • Cameron R.P.
      • Hulsizer M.R.
      Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.
      Health Psychol. 2000; 19: 576-585
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Affonso D.
      Predictors of depression symptoms during pregnancy and postpartum.
      J Psychosom Obstet Gynaecol. 1991; 12: 255
      , 
      • Bergner A.
      • Beyer R.
      • Klapp B.F.
      • Rauchfuss M.
      Pregnancy after early pregnancy loss: a prospective study of anxiety, depressive symptomatology and coping.
      J Psychosom Obstet Gynaecol. 2008; 29: 105-113
      , 
      • Bernazzani O.
      • Saucier J.F.
      • David H.
      • Borgeat F.
      Psychosocial factors related to emotional disturbances during pregnancy.
      J Psychosom Res. 1997; 42: 391-402
      , 
      • Blaney N.T.
      • Fernandez M.I.
      • Ethier K.A.
      • Wilson T.E.
      • Walter E.
      • Koenig L.J.
      Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.
      AIDS Patient Care STDS. 2004; 18: 405-415
      , 
      • Da Costa D.
      • Larouche J.
      • Dritsa M.
      • Brender W.
      Psychosocial correlates of prepartum and postpartum depressed mood.
      J Affect Disord. 2000; 59: 31-40
      , 
      • Heaman M.
      Stressful life events, social support, and mood disturbance in hospitalized and non-hospitalized women with pregnancy-induced hypertension.
      Can J Nurs Res. 1992; 24: 23-37
      , 
      • Hoffman S.
      • Hatch M.C.
      Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.
      Health Psychol. 2000; 19: 535-543
      , 
      • Jesse D.E.
      • Seaver D.C.
      • William W.W.
      Maternal psychosocial risks predict preterm birth in a group of women from Appalachia.
      Midwifery. 2003; 19: 191-202
      , 
      • Rubertsson C.
      Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample.
      J Reprod Infant Psychol. 2003; 21: 113-123
      , 
      • Seguin L.
      • Potvin L.
      • St-Denis M.
      • Loiselle J.
      Chronic stressors, social support, and depression during pregnancy.
      Obstet Gynecol. 1995; 85: 583-589
      , 
      • Zayas L.H.
      • Jankowski K.R.
      • McKee M.D.
      Prenatal and postpartum depression among low-income Dominican and Puerto Rican women.
      Hispanic J Behav Sci. 2003; 25: 370-385
      , 
      • Zelkowitz P.
      • Schinazi J.
      • Katofsky L.
      • et al.
      Factors associated with depression in pregnant immigrant women.
      Transcultural Psychiatry. 2004; 41: 445-464
      		189973++++++
       Life events, total (positive and negative)159645+++Inconsistent
       Negative life events+++++++
       Daily hassles51134
      No effect.
      Could not give summary due to lack of sample size (see text for discussion);
      Personal history of depression
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Flynn H.A.
      • Walton M.A.
      • Chermack S.T.
      • Cunningham R.M.
      • Marcus S.M.
      Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings.
      Arch Womens Ment Health. 2007; 10: 155-161
      , 
      • O'Heron C.A.
      Coping and postpartum depression: an analysis of coping and depression during pregnancy and the puerperium [dissertation].
      University of Missouri–St Louis, St Louis, MO1991
      , 
      • Seguin L.
      • Potvin L.
      • St-Denis M.
      • Loiselle J.
      Chronic stressors, social support, and depression during pregnancy.
      Obstet Gynecol. 1995; 85: 583-589
      , 
      • Zuckerman B.
      • Bauchner H.
      • Parker S.
      • Cabral H.
      Maternal depressive symptoms during pregnancy, and newborn irritability.
      J Dev Behav Pediatr. 1990; 11: 190-194
      		63566+++
      Could not give summary due to lack of sample size (see text for discussion);
      Social support
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      , 
      • Morse C.A.
      • Buist A.
      • Durkin S.
      First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers.
      J Psychosom Obstet Gynaecol. 2000; 21: 109-120
      , 
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      , 
      • Kleiverda G.
      • Steen A.M.
      • Andersen I.
      • Everaerd W.
      • Treffers P.E.
      Physical and psychological well-being in working nulliparous women during pregnancy.
      J Psychosoma Obstet Gynaecol. 1990; 11: 165-184
      , 
      • Berle J.O.
      • Mykletun A.
      • Daltveit A.K.
      • Rasmussen S.
      • Holsten F.
      • Dahl A.A.
      Neonatal outcomes in offspring of women with anxiety and depression during pregnancy: a linkage study from the Nord-Trondelag health study (HUNT) and medical birth registry of Norway.
      Arch Womens Ment Health. 2005; 8: 181-189
      , 
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Ritter C.
      • Hobfoll S.E.
      • Lavin J.
      • Cameron R.P.
      • Hulsizer M.R.
      Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.
      Health Psychol. 2000; 19: 576-585
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      , 
      • Nicholson W.K.
      • Setse R.
      • Hill-Briggs F.
      • Cooper L.A.
      • Strobino D.
      • Powe N.R.
      Depressive symptoms and health-related quality of life in early pregnancy.
      Obstet Gynecol. 2006; 107: 798-806
      , 
      • Westdahl C.
      • Milan S.
      • Magriples U.
      • Kershaw T.S.
      • Rising S.S.
      • Ickovics J.R.
      Social support and social conflict as predictors of prenatal depression.
      Obstet Gynecol. 2007; 110: 134-140
      , 
      • Affonso D.
      Predictors of depression symptoms during pregnancy and postpartum.
      J Psychosom Obstet Gynaecol. 1991; 12: 255
      , 
      • Bernazzani O.
      • Saucier J.F.
      • David H.
      • Borgeat F.
      Psychosocial factors related to emotional disturbances during pregnancy.
      J Psychosom Res. 1997; 42: 391-402
      , 
      • Blaney N.T.
      • Fernandez M.I.
      • Ethier K.A.
      • Wilson T.E.
      • Walter E.
      • Koenig L.J.
      Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.
      AIDS Patient Care STDS. 2004; 18: 405-415
      , 
      • Da Costa D.
      • Larouche J.
      • Dritsa M.
      • Brender W.
      Psychosocial correlates of prepartum and postpartum depressed mood.
      J Affect Disord. 2000; 59: 31-40
      , 
      • Elsenbruch S.
      • Benson S.
      • Rucke M.
      • et al.
      Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome.
      Hum Reprod. 2007; 22: 869-877
      , 
      • Heaman M.
      Stressful life events, social support, and mood disturbance in hospitalized and non-hospitalized women with pregnancy-induced hypertension.
      Can J Nurs Res. 1992; 24: 23-37
      , 
      • Hoffman S.
      • Hatch M.C.
      Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.
      Health Psychol. 2000; 19: 535-543
      , 
      • Jesse D.E.
      • Seaver D.C.
      • William W.W.
      Maternal psychosocial risks predict preterm birth in a group of women from Appalachia.
      Midwifery. 2003; 19: 191-202
      , 
      • Leathers S.J.
      • Kelley M.A.
      Unintended pregnancy and depressive symptoms among first-time mothers and fathers.
      Am J Orthopsychiatry. 2000; 70: 523-531
      , 
      • Pajulo M.
      • Savonlahti E.
      • Sourander A.
      • Helenius H.
      • Piha J.
      Antenatal depression, substance dependency and social support.
      J Affect Disord. 2001; 65: 9-17
      , 
      • Rubertsson C.
      Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample.
      J Reprod Infant Psychol. 2003; 21: 113-123
      , 
      • Seguin L.
      • Potvin L.
      • St-Denis M.
      • Loiselle J.
      Chronic stressors, social support, and depression during pregnancy.
      Obstet Gynecol. 1995; 85: 583-589
      , 
      • Zelkowitz P.
      • Schinazi J.
      • Katofsky L.
      • et al.
      Factors associated with depression in pregnant immigrant women.
      Transcultural Psychiatry. 2004; 41: 445-464
       Lack of social support, any source175752++++
       Lack of social support, partner97139++++++++
      Domestic violence
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      , 
      • Holzman C.
      • Eyster J.
      • Tiedje L.B.
      • Roman L.A.
      • Seagull E.
      • Rahbar M.H.
      A life course perspective on depressive symptoms in mid-pregnancy.
      Matern Child Health J. 2006; 10: 127-138
      , 
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Bennett I.M.
      • Culhane J.F.
      • McCollum K.F.
      • Mathew L.
      • Elo I.T.
      Literacy and depressive symptomatology among pregnant Latinas with limited English proficiency.
      Am J Orthopsychiatry. 2007; 77: 243-248
      , 
      • Flynn H.A.
      • Walton M.A.
      • Chermack S.T.
      • Cunningham R.M.
      • Marcus S.M.
      Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings.
      Arch Womens Ment Health. 2007; 10: 155-161
      , 
      • Jesse D.E.
      • Seaver D.C.
      • William W.W.
      Maternal psychosocial risks predict preterm birth in a group of women from Appalachia.
      Midwifery. 2003; 19: 191-202
      , 
      • Rodriguez M.A.
      • Heilemann M.V.
      • Fielder E.
      • Ang A.
      • Nevarez F.
      • Mangione C.M.
      Intimate partner violence, depression, and PTSD among pregnant Latina women.
      Ann Fam Med. 2008; 6: 44-52
      		73738+++
      Unintended pregnancy
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      , 
      • Leathers S.J.
      • Kelley M.A.
      Unintended pregnancy and depressive symptoms among first-time mothers and fathers.
      Am J Orthopsychiatry. 2000; 70: 523-531
      , 
      • Najman J.M.
      • Morrison J.
      • Williams G.
      • Andersen M.
      • Keeping J.D.
      The mental health of women 6 months after they give birth to an unwanted baby: a longitudinal study.
      Soc Sci Med. 1991; 32: 241-247
      , 
      • Orr S.T.
      • Miller C.A.
      Unintended pregnancy and the psychosocial well-being of pregnant women.
      Womens Health Issues. 1997; 7: 38-46
      , 
      • Pajulo M.
      • Savonlahti E.
      • Sourander A.
      • Helenius H.
      • Piha J.
      Antenatal depression, substance dependency and social support.
      J Affect Disord. 2001; 65: 9-17
      , 
      • Rubertsson C.
      Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample.
      J Reprod Infant Psychol. 2003; 21: 113-123
      		611,470+++
      Could not give summary due to lack of sample size (see text for discussion);
      Relationships
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      , 
      • Morse C.A.
      • Buist A.
      • Durkin S.
      First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers.
      J Psychosom Obstet Gynaecol. 2000; 21: 109-120
      , 
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      , 
      • Kleiverda G.
      • Steen A.M.
      • Andersen I.
      • Everaerd W.
      • Treffers P.E.
      Physical and psychological well-being in working nulliparous women during pregnancy.
      J Psychosoma Obstet Gynaecol. 1990; 11: 165-184
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      , 
      • Nicholson W.K.
      • Setse R.
      • Hill-Briggs F.
      • Cooper L.A.
      • Strobino D.
      • Powe N.R.
      Depressive symptoms and health-related quality of life in early pregnancy.
      Obstet Gynecol. 2006; 107: 798-806
      , 
      • Westdahl C.
      • Milan S.
      • Magriples U.
      • Kershaw T.S.
      • Rising S.S.
      • Ickovics J.R.
      Social support and social conflict as predictors of prenatal depression.
      Obstet Gynecol. 2007; 110: 134-140
      , 
      • Flynn H.A.
      • Marcus S.M.
      • Barry K.L.
      • Blow F.C.
      Rates and correlates of alcohol use among pregnant women in obstetrics clinics.
      Alcohol Clin Exp Res. 2003; 27: 81-87
      , 
      • Lindgren K.
      Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy.
      Res Nurs Health. 2001; 24: 203-217
      , 
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      , 
      • Affonso D.
      Predictors of depression symptoms during pregnancy and postpartum.
      J Psychosom Obstet Gynaecol. 1991; 12: 255
      , 
      • Bennett I.M.
      • Culhane J.F.
      • McCollum K.F.
      • Mathew L.
      • Elo I.T.
      Literacy and depressive symptomatology among pregnant Latinas with limited English proficiency.
      Am J Orthopsychiatry. 2007; 77: 243-248
      , 
      • Bernazzani O.
      • Saucier J.F.
      • David H.
      • Borgeat F.
      Psychosocial factors related to emotional disturbances during pregnancy.
      J Psychosom Res. 1997; 42: 391-402
      , 
      • Cooklin A.R.
      • Rowe H.J.
      • Fisher J.R.
      Employee entitlements during pregnancy and maternal psychological well-being.
      Aust N Z J Obstet Gynaecol. 2007; 47: 483-490
      , 
      • Da Costa D.
      • Larouche J.
      • Dritsa M.
      • Brender W.
      Psychosocial correlates of prepartum and postpartum depressed mood.
      J Affect Disord. 2000; 59: 31-40
      , 
      • Larsson C.
      • Sydsjö G.
      • Josefsson A.
      Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms.
      Obstet Gynecol. 2004; 104: 459-466
      , 
      • Leathers S.J.
      • Kelley M.A.
      Unintended pregnancy and depressive symptoms among first-time mothers and fathers.
      Am J Orthopsychiatry. 2000; 70: 523-531
      , 
      • O'Heron C.A.
      Coping and postpartum depression: an analysis of coping and depression during pregnancy and the puerperium [dissertation].
      University of Missouri–St Louis, St Louis, MO1991
      , 
      • Pajulo M.
      • Savonlahti E.
      • Sourander A.
      • Helenius H.
      • Piha J.
      Antenatal depression, substance dependency and social support.
      J Affect Disord. 2001; 65: 9-17
      , 
      • Pascoe J.M.
      • Milburn M.
      • Haynes K.
      Correlates of first trimester care in a public health prenatal clinic.
      Fam Med. 1990; 22: 25-28
      , 
      • Rubertsson C.
      Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample.
      J Reprod Infant Psychol. 2003; 21: 113-123
      , 
      • Seguin L.
      • Potvin L.
      • St-Denis M.
      • Loiselle J.
      Chronic stressors, social support, and depression during pregnancy.
      Obstet Gynecol. 1995; 85: 583-589
      , 
      • Tilden V.P.
      The relation of selected psychosocial variables to single status of adult women during pregnancy.
      Nurs Res. 1984; 33: 102-107
      , 
      • van de Pol G.G.
      • Van Brummen H.J.
      • Bruinse H.W.
      • Heintz A.P.
      • Van Der Vaart C.H.
      Is there an association between depressive and urinary symptoms during and after pregnancy?.
      Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 1409-1415
      , 
      • Zayas L.H.
      • Jankowski K.R.
      • McKee M.D.
      Prenatal and postpartum depression among low-income Dominican and Puerto Rican women.
      Hispanic J Behav Sci. 2003; 25: 370-385
      , 
      • Zelkowitz P.
      • Schinazi J.
      • Katofsky L.
      • et al.
      Factors associated with depression in pregnant immigrant women.
      Transcultural Psychiatry. 2004; 41: 445-464
       Cohabitation1912,483++Inconsistent
       Poor relationship quality114005+++
      No effect.
      Demographics
       Public insurance/uninsured
      • Holzman C.
      • Eyster J.
      • Tiedje L.B.
      • Roman L.A.
      • Seagull E.
      • Rahbar M.H.
      A life course perspective on depressive symptoms in mid-pregnancy.
      Matern Child Health J. 2006; 10: 127-138
      , 
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Nicholson W.K.
      • Setse R.
      • Hill-Briggs F.
      • Cooper L.A.
      • Strobino D.
      • Powe N.R.
      Depressive symptoms and health-related quality of life in early pregnancy.
      Obstet Gynecol. 2006; 107: 798-806
      , 
      • Cooklin A.R.
      • Rowe H.J.
      • Fisher J.R.
      Employee entitlements during pregnancy and maternal psychological well-being.
      Aust N Z J Obstet Gynaecol. 2007; 47: 483-490
      , 
      • Jesse D.E.
      • Seaver D.C.
      • William W.W.
      Maternal psychosocial risks predict preterm birth in a group of women from Appalachia.
      Midwifery. 2003; 19: 191-202
      , 
      • Jesse D.E.
      Prenatal psychosocial needs: differences between a TennCare group and a privately insured group in Appalachia.
      J Health Care Poor Underserved. 2003; 14: 535-549
      		62008+++
      Could not give summary due to lack of sample size (see text for discussion);
       Medicaid (US studies only)+++
      Could not give summary due to lack of sample size (see text for discussion);
       Socioeconomic status
      • Hoffman S.
      • Hatch M.C.
      Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.
      Health Psychol. 2000; 19: 535-543
      , 
      • Larsson C.
      • Sydsjö G.
      • Josefsson A.
      Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms.
      Obstet Gynecol. 2004; 104: 459-466
      , 
      • Pajulo M.
      • Savonlahti E.
      • Sourander A.
      • Helenius H.
      • Piha J.
      Antenatal depression, substance dependency and social support.
      J Affect Disord. 2001; 65: 9-17
      , 
      • Seguin L.
      • Potvin L.
      • St-Denis M.
      • Loiselle J.
      Chronic stressors, social support, and depression during pregnancy.
      Obstet Gynecol. 1995; 85: 583-589
      , 
      • Zelkowitz P.
      • Schinazi J.
      • Katofsky L.
      • et al.
      Factors associated with depression in pregnant immigrant women.
      Transcultural Psychiatry. 2004; 41: 445-464
      		52805
      No effect.
      No effect.
       Lower income
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      , 
      • Ritter C.
      • Hobfoll S.E.
      • Lavin J.
      • Cameron R.P.
      • Hulsizer M.R.
      Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.
      Health Psychol. 2000; 19: 576-585
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Lindgren K.
      Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy.
      Res Nurs Health. 2001; 24: 203-217
      , 
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      , 
      • Hobfoll S.E.
      • Ritter C.
      • Lavin J.
      • Hulsizer M.R.
      • Cameron R.P.
      Depression prevalence and incidence among inner-city pregnant and postpartum women.
      J Consult Clin Psychol. 1995; 63: 445-453
      , 
      • Bennett I.M.
      • Culhane J.F.
      • McCollum K.F.
      • Mathew L.
      • Elo I.T.
      Literacy and depressive symptomatology among pregnant Latinas with limited English proficiency.
      Am J Orthopsychiatry. 2007; 77: 243-248
      , 
      • Bernazzani O.
      • Saucier J.F.
      • David H.
      • Borgeat F.
      Psychosocial factors related to emotional disturbances during pregnancy.
      J Psychosom Res. 1997; 42: 391-402
      , 
      • Blaney N.T.
      • Fernandez M.I.
      • Ethier K.A.
      • Wilson T.E.
      • Walter E.
      • Koenig L.J.
      Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.
      AIDS Patient Care STDS. 2004; 18: 405-415
      , 
      • Hoffman S.
      • Hatch M.C.
      Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.
      Health Psychol. 2000; 19: 535-543
      , 
      • Pajulo M.
      • Savonlahti E.
      • Sourander A.
      • Helenius H.
      • Piha J.
      Antenatal depression, substance dependency and social support.
      J Affect Disord. 2001; 65: 9-17
      		116285+
      Could not give summary due to lack of sample size (see text for discussion);
       Unemployment
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      , 
      • Kleiverda G.
      • Steen A.M.
      • Andersen I.
      • Everaerd W.
      • Treffers P.E.
      Physical and psychological well-being in working nulliparous women during pregnancy.
      J Psychosoma Obstet Gynaecol. 1990; 11: 165-184
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Westdahl C.
      • Milan S.
      • Magriples U.
      • Kershaw T.S.
      • Rising S.S.
      • Ickovics J.R.
      Social support and social conflict as predictors of prenatal depression.
      Obstet Gynecol. 2007; 110: 134-140
      , 
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      , 
      • Hobfoll S.E.
      • Ritter C.
      • Lavin J.
      • Hulsizer M.R.
      • Cameron R.P.
      Depression prevalence and incidence among inner-city pregnant and postpartum women.
      J Consult Clin Psychol. 1995; 63: 445-453
      , 
      • Bergner A.
      • Beyer R.
      • Klapp B.F.
      • Rauchfuss M.
      Pregnancy after early pregnancy loss: a prospective study of anxiety, depressive symptomatology and coping.
      J Psychosom Obstet Gynaecol. 2008; 29: 105-113
      , 
      • Blaney N.T.
      • Fernandez M.I.
      • Ethier K.A.
      • Wilson T.E.
      • Walter E.
      • Koenig L.J.
      Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.
      AIDS Patient Care STDS. 2004; 18: 405-415
      , 
      • Cooklin A.R.
      • Rowe H.J.
      • Fisher J.R.
      Employee entitlements during pregnancy and maternal psychological well-being.
      Aust N Z J Obstet Gynaecol. 2007; 47: 483-490
      , 
      • Pajulo M.
      • Savonlahti E.
      • Sourander A.
      • Helenius H.
      • Piha J.
      Antenatal depression, substance dependency and social support.
      J Affect Disord. 2001; 65: 9-17
      , 
      • Rubertsson C.
      Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample.
      J Reprod Infant Psychol. 2003; 21: 113-123
      , 
      • van de Pol G.G.
      • Van Brummen H.J.
      • Bruinse H.W.
      • Heintz A.P.
      • Van Der Vaart C.H.
      Is there an association between depressive and urinary symptoms during and after pregnancy?.
      Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 1409-1415
      , 
      • Zayas L.H.
      • Jankowski K.R.
      • McKee M.D.
      Prenatal and postpartum depression among low-income Dominican and Puerto Rican women.
      Hispanic J Behav Sci. 2003; 25: 370-385
      , 
      • Zelkowitz P.
      • Schinazi J.
      • Katofsky L.
      • et al.
      Factors associated with depression in pregnant immigrant women.
      Transcultural Psychiatry. 2004; 41: 445-464
      		149417
      No effect.
      		Inconsistent
       Lower education
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      , 
      • Grant K.A.
      • McMahon C.C.
      • Austin M.P.
      Maternal anxiety during the transition to parenthood: a prospective study.
      J Affect Disord. 2008; 108: 101-111
      , 
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      , 
      • Nicholson W.K.
      • Setse R.
      • Hill-Briggs F.
      • Cooper L.A.
      • Strobino D.
      • Powe N.R.
      Depressive symptoms and health-related quality of life in early pregnancy.
      Obstet Gynecol. 2006; 107: 798-806
      , 
      • Westdahl C.
      • Milan S.
      • Magriples U.
      • Kershaw T.S.
      • Rising S.S.
      • Ickovics J.R.
      Social support and social conflict as predictors of prenatal depression.
      Obstet Gynecol. 2007; 110: 134-140
      , 
      • Flynn H.A.
      • Marcus S.M.
      • Barry K.L.
      • Blow F.C.
      Rates and correlates of alcohol use among pregnant women in obstetrics clinics.
      Alcohol Clin Exp Res. 2003; 27: 81-87
      , 
      • Lindgren K.
      Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy.
      Res Nurs Health. 2001; 24: 203-217
      , 
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      , 
      • Hobfoll S.E.
      • Ritter C.
      • Lavin J.
      • Hulsizer M.R.
      • Cameron R.P.
      Depression prevalence and incidence among inner-city pregnant and postpartum women.
      J Consult Clin Psychol. 1995; 63: 445-453
      , 
      • Affonso D.
      Predictors of depression symptoms during pregnancy and postpartum.
      J Psychosom Obstet Gynaecol. 1991; 12: 255
      , 
      • Blaney N.T.
      • Fernandez M.I.
      • Ethier K.A.
      • Wilson T.E.
      • Walter E.
      • Koenig L.J.
      Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.
      AIDS Patient Care STDS. 2004; 18: 405-415
      , 
      • Cooklin A.R.
      • Rowe H.J.
      • Fisher J.R.
      Employee entitlements during pregnancy and maternal psychological well-being.
      Aust N Z J Obstet Gynaecol. 2007; 47: 483-490
      , 
      • Hoffman S.
      • Hatch M.C.
      Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.
      Health Psychol. 2000; 19: 535-543
      , 
      • O'Heron C.A.
      Coping and postpartum depression: an analysis of coping and depression during pregnancy and the puerperium [dissertation].
      University of Missouri–St Louis, St Louis, MO1991
      , 
      • Rubertsson C.
      Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample.
      J Reprod Infant Psychol. 2003; 21: 113-123
      , 
      • van de Pol G.G.
      • Van Brummen H.J.
      • Bruinse H.W.
      • Heintz A.P.
      • Van Der Vaart C.H.
      Is there an association between depressive and urinary symptoms during and after pregnancy?.
      Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 1409-1415
      , 
      • Zayas L.H.
      • Jankowski K.R.
      • McKee M.D.
      Prenatal and postpartum depression among low-income Dominican and Puerto Rican women.
      Hispanic J Behav Sci. 2003; 25: 370-385
      , 
      • Zelkowitz P.
      • Schinazi J.
      • Katofsky L.
      • et al.
      Factors associated with depression in pregnant immigrant women.
      Transcultural Psychiatry. 2004; 41: 445-464
      		2011,529+
      No effect.
       Maternal age
      • Glazier R.H.
      • Elgar F.J.
      • Goel V.
      • Holzapfel S.
      Stress, social support, and emotional distress in a community sample of pregnant women.
      J Psychosom Obstet Gynaecol. 2004; 25: 247-255
      , 
      • Morse C.A.
      • Buist A.
      • Durkin S.
      First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers.
      J Psychosom Obstet Gynaecol. 2000; 21: 109-120
      , 
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      , 
      • Nicholson W.K.
      • Setse R.
      • Hill-Briggs F.
      • Cooper L.A.
      • Strobino D.
      • Powe N.R.
      Depressive symptoms and health-related quality of life in early pregnancy.
      Obstet Gynecol. 2006; 107: 798-806
      , 
      • Westdahl C.
      • Milan S.
      • Magriples U.
      • Kershaw T.S.
      • Rising S.S.
      • Ickovics J.R.
      Social support and social conflict as predictors of prenatal depression.
      Obstet Gynecol. 2007; 110: 134-140
      , 
      • Flynn H.A.
      • Marcus S.M.
      • Barry K.L.
      • Blow F.C.
      Rates and correlates of alcohol use among pregnant women in obstetrics clinics.
      Alcohol Clin Exp Res. 2003; 27: 81-87
      , 
      • Lindgren K.
      Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy.
      Res Nurs Health. 2001; 24: 203-217
      , 
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      , 
      • Hobfoll S.E.
      • Ritter C.
      • Lavin J.
      • Hulsizer M.R.
      • Cameron R.P.
      Depression prevalence and incidence among inner-city pregnant and postpartum women.
      J Consult Clin Psychol. 1995; 63: 445-453
      , 
      • Affonso D.
      Predictors of depression symptoms during pregnancy and postpartum.
      J Psychosom Obstet Gynaecol. 1991; 12: 255
      , 
      • Bennett I.M.
      • Culhane J.F.
      • McCollum K.F.
      • Mathew L.
      • Elo I.T.
      Literacy and depressive symptomatology among pregnant Latinas with limited English proficiency.
      Am J Orthopsychiatry. 2007; 77: 243-248
      , 
      • Bernazzani O.
      • Saucier J.F.
      • David H.
      • Borgeat F.
      Psychosocial factors related to emotional disturbances during pregnancy.
      J Psychosom Res. 1997; 42: 391-402
      , 
      • Blaney N.T.
      • Fernandez M.I.
      • Ethier K.A.
      • Wilson T.E.
      • Walter E.
      • Koenig L.J.
      Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.
      AIDS Patient Care STDS. 2004; 18: 405-415
      , 
      • Larsson C.
      • Sydsjö G.
      • Josefsson A.
      Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms.
      Obstet Gynecol. 2004; 104: 459-466
      , 
      • O'Heron C.A.
      Coping and postpartum depression: an analysis of coping and depression during pregnancy and the puerperium [dissertation].
      University of Missouri–St Louis, St Louis, MO1991
      , 
      • Pajulo M.
      • Savonlahti E.
      • Sourander A.
      • Helenius H.
      • Piha J.
      Antenatal depression, substance dependency and social support.
      J Affect Disord. 2001; 65: 9-17
      , 
      • Rodriguez M.A.
      • Heilemann M.V.
      • Fielder E.
      • Ang A.
      • Nevarez F.
      • Mangione C.M.
      Intimate partner violence, depression, and PTSD among pregnant Latina women.
      Ann Fam Med. 2008; 6: 44-52
      , 
      • Rubertsson C.
      Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample.
      J Reprod Infant Psychol. 2003; 21: 113-123
      , 
      • van de Pol G.G.
      • Van Brummen H.J.
      • Bruinse H.W.
      • Heintz A.P.
      • Van Der Vaart C.H.
      Is there an association between depressive and urinary symptoms during and after pregnancy?.
      Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 1409-1415
      , 
      • Zelkowitz P.
      • Schinazi J.
      • Katofsky L.
      • et al.
      Factors associated with depression in pregnant immigrant women.
      Transcultural Psychiatry. 2004; 41: 445-464
      		2213,837Inconsistent
      No effect.
       Maternal race/ethnicity
      • Holzman C.
      • Eyster J.
      • Tiedje L.B.
      • Roman L.A.
      • Seagull E.
      • Rahbar M.H.
      A life course perspective on depressive symptoms in mid-pregnancy.
      Matern Child Health J. 2006; 10: 127-138
      , 
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Ritter C.
      • Hobfoll S.E.
      • Lavin J.
      • Cameron R.P.
      • Hulsizer M.R.
      Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.
      Health Psychol. 2000; 19: 576-585
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      , 
      • Nicholson W.K.
      • Setse R.
      • Hill-Briggs F.
      • Cooper L.A.
      • Strobino D.
      • Powe N.R.
      Depressive symptoms and health-related quality of life in early pregnancy.
      Obstet Gynecol. 2006; 107: 798-806
      , 
      • Westdahl C.
      • Milan S.
      • Magriples U.
      • Kershaw T.S.
      • Rising S.S.
      • Ickovics J.R.
      Social support and social conflict as predictors of prenatal depression.
      Obstet Gynecol. 2007; 110: 134-140
      , 
      • Flynn H.A.
      • Marcus S.M.
      • Barry K.L.
      • Blow F.C.
      Rates and correlates of alcohol use among pregnant women in obstetrics clinics.
      Alcohol Clin Exp Res. 2003; 27: 81-87
      , 
      • Lindgren K.
      Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy.
      Res Nurs Health. 2001; 24: 203-217
      , 
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      , 
      • Hobfoll S.E.
      • Ritter C.
      • Lavin J.
      • Hulsizer M.R.
      • Cameron R.P.
      Depression prevalence and incidence among inner-city pregnant and postpartum women.
      J Consult Clin Psychol. 1995; 63: 445-453
      , 
      • Smith M.V.
      • Brunetto W.L.
      • Yonkers K.A.
      Identifying perinatal depression–sooner is better.
      Contemp OB/GYN. 2004; 49: 58
      , 
      • Ward K.D.
      • Vander Weg M.W.
      • Sell M.A.
      • Scarinci I.C.
      • Read M.C.
      Characteristics and correlates of quitting among black and white low-income pregnant smokers.
      Am J Health Behav. 2006; 30: 651-662
      , 
      • Edge D.
      • Baker D.
      • Rogers A.
      Perinatal depression among black Caribbean women.
      Health Soc Care Community. 2004; 12: 430-438
      		146671Inconsistent
      No effect.
      Substance abuse
       Smoking
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      , 
      • Flynn H.A.
      • Marcus S.M.
      • Barry K.L.
      • Blow F.C.
      Rates and correlates of alcohol use among pregnant women in obstetrics clinics.
      Alcohol Clin Exp Res. 2003; 27: 81-87
      , 
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      , 
      • Ward K.D.
      • Vander Weg M.W.
      • Sell M.A.
      • Scarinci I.C.
      • Read M.C.
      Characteristics and correlates of quitting among black and white low-income pregnant smokers.
      Am J Health Behav. 2006; 30: 651-662
      , 
      • Flynn H.A.
      • Walton M.A.
      • Chermack S.T.
      • Cunningham R.M.
      • Marcus S.M.
      Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings.
      Arch Womens Ment Health. 2007; 10: 155-161
      , 
      • Hoffman S.
      • Hatch M.C.
      Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.
      Health Psychol. 2000; 19: 535-543
      , 
      • Jesse D.E.
      • Seaver D.C.
      • William W.W.
      Maternal psychosocial risks predict preterm birth in a group of women from Appalachia.
      Midwifery. 2003; 19: 191-202
      , 
      • Larsson C.
      • Sydsjö G.
      • Josefsson A.
      Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms.
      Obstet Gynecol. 2004; 104: 459-466
      , 
      • van de Pol G.G.
      • Van Brummen H.J.
      • Bruinse H.W.
      • Heintz A.P.
      • Van Der Vaart C.H.
      Is there an association between depressive and urinary symptoms during and after pregnancy?.
      Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 1409-1415
      		116641+
      No effect.
       Alcohol use
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      , 
      • Flynn H.A.
      • Marcus S.M.
      • Barry K.L.
      • Blow F.C.
      Rates and correlates of alcohol use among pregnant women in obstetrics clinics.
      Alcohol Clin Exp Res. 2003; 27: 81-87
      , 
      • Alati R.
      • Lawlor D.A.
      • Najman J.M.
      • Williams G.M.
      • Bor W.
      • O'Callaghan M.
      Is there really a ‘J-shaped' curve in the association between alcohol consumption and symptoms of depression and anxiety? Findings from the Mater-University study of pregnancy and its outcomes.
      Addiction. 2005; 100: 643-651
      , 
      • Alvik A.
      • Haldorsen T.
      • Groholt B.
      • Lindemann R.
      Alcohol consumption before and during pregnancy comparing concurrent and retrospective reports.
      Alcohol Clin Exp Res. 2006; 30: 510-515
      , 
      • Flynn H.A.
      • Walton M.A.
      • Chermack S.T.
      • Cunningham R.M.
      • Marcus S.M.
      Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings.
      Arch Womens Ment Health. 2007; 10: 155-161
      , 
      • Hoffman S.
      • Hatch M.C.
      Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women.
      Health Psychol. 2000; 19: 535-543
      , 
      • Jesse D.E.
      • Seaver D.C.
      • William W.W.
      Maternal psychosocial risks predict preterm birth in a group of women from Appalachia.
      Midwifery. 2003; 19: 191-202
      , 
      • Pascoe J.M.
      • Kokotailo P.K.
      • Broekhuizen F.F.
      Correlates of multigravida women's binge drinking during pregnancy: a longitudinal study.
      Arch Pediatr Adolesc Med. 1995; 149: 1325-1329
      , 
      • van de Pol G.G.
      • Van Brummen H.J.
      • Bruinse H.W.
      • Heintz A.P.
      • Van Der Vaart C.H.
      Is there an association between depressive and urinary symptoms during and after pregnancy?.
      Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 1409-1415
      		1010,621Inconsistent
      No effect.
       Illicit drug use
      • Jesse D.E.
      • Walcott-McQuigg J.
      • Mariella A.
      • Swanson M.S.
      Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.
      J Midwifery Womens Health. 2005; 50: 405-410
      , 
      • Zuckerman B.
      • Amaro H.
      • Bauchner H.
      • Cabral H.
      Depressive symptoms during pregnancy: relationship to poor health behaviors.
      Am J Obstet Gynecol. 1989; 160: 1107-1111
      , 
      • Bowen A.
      • Muhajarine N.
      Prevalence of antenatal depression in women enrolled in an outreach program in Canada.
      J Obstet Gynecol Neonatal Nurs. 2006; 35: 491-498
      , 
      • Vander Weg M.W.
      • Ward K.D.
      • Scarinci I.C.
      • Read M.C.
      • Evans C.B.
      Smoking-related correlates of depressive symptoms in low-income pregnant women.
      Am J Health Behav. 2004; 28: 510-521
      , 
      • Bennett I.M.
      • Culhane J.F.
      • McCollum K.F.
      • Mathew L.
      • Elo I.T.
      Literacy and depressive symptomatology among pregnant Latinas with limited English proficiency.
      Am J Orthopsychiatry. 2007; 77: 243-248
      , 
      • Blaney N.T.
      • Fernandez M.I.
      • Ethier K.A.
      • Wilson T.E.
      • Walter E.
      • Koenig L.J.
      Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.
      AIDS Patient Care STDS. 2004; 18: 405-415
      , 
      • Jesse D.E.
      • Seaver D.C.
      • William W.W.
      Maternal psychosocial risks predict preterm birth in a group of women from Appalachia.
      Midwifery. 2003; 19: 191-202
      , 
      • Pajulo M.
      • Savonlahti E.
      • Sourander A.
      • Helenius H.
      • Piha J.
      Antenatal depression, substance dependency and social support.
      J Affect Disord. 2001; 65: 9-17
      		83010
      No effect.
      		Inconsistent
      Nulliparity
      • Morse C.A.
      • Buist A.
      • Durkin S.
      First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers.
      J Psychosom Obstet Gynaecol. 2000; 21: 109-120
      , 
      • Records K.
      • Rice M.
      Psychosocial correlates of depression symptoms during the third trimester of pregnancy.
      J Obstet Gynecol Neonatal Nurs. 2007; 36: 231-242
      , 
      • Nicholson W.K.
      • Setse R.
      • Hill-Briggs F.
      • Cooper L.A.
      • Strobino D.
      • Powe N.R.
      Depressive symptoms and health-related quality of life in early pregnancy.
      Obstet Gynecol. 2006; 107: 798-806
      , 
      • Westdahl C.
      • Milan S.
      • Magriples U.
      • Kershaw T.S.
      • Rising S.S.
      • Ickovics J.R.
      Social support and social conflict as predictors of prenatal depression.
      Obstet Gynecol. 2007; 110: 134-140
      , 
      • Flynn H.A.
      • Marcus S.M.
      • Barry K.L.
      • Blow F.C.
      Rates and correlates of alcohol use among pregnant women in obstetrics clinics.
      Alcohol Clin Exp Res. 2003; 27: 81-87
      , 
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